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AVAILITY

Fetch claims

Search claim status for a patient.

POSThttps://preview.ontross.com/api/integrations/availity/fetch-claims
Request Fields
input.org_name
string
required
Organization name as Availity registers it, but the submitting provider's organization for attachments.
Example
"Example Ridge Orthopedic Clinic"
input.first_name
string
Patient's given name as the payer holds it.
Example
"Elena"
input.last_name
string
Patient's family name as the payer holds it.
Example
"Whitcomb"
input.member_id
string
Member number from the insurance card, sent as patient and subscriber.
Example
"W000009876"
input.date_of_service
string
Service date searched, sent as both the from and to date.
Example
"2026-04-07"
input.date_of_birth
string
Patient date of birth, YYYY-MM-DD for claim search and MM/DD/YYYY for attachments.
Example
"1988-09-23"
input.payer
string
Payer name exactly as Availity's payer list spells it.
Example
"AETNA (COMMERCIAL & MEDICARE)"
auth_id
string
required
Saved connection to run this operation through, from the Authentication page. It decides which practice and login the call uses.
Example
"00000000-0000-4000-8000-000000000000"
Output Fields
claims
array
One entry per claim returned by the search.
claims[].claimNumber
string
Payer's control number for the claim under review.
Example
"2609700001234"
claims[].claimType
string
Claim form family, for example professional or institutional.
Example
"PROFESSIONAL"
claims[].status
string
Payer's reported processing outcome for the entire claim.
Example
"Finalized"
claims[].statusCode
string
Payer's X12 claim status code.
Example
"65"
claims[].statusCodeDescription
string
Plain wording for that claim status code.
Example
"Claim/line has been paid."
claims[].categoryCode
string
X12 claim status category code for the claim.
Example
"F1"
claims[].categoryCodeDescription
string
Plain wording for the status category code.
Example
"Finalized/Payment"
claims[].receivedDate
string
Date the payer received the claim.
Example
"2026-04-09"
claims[].finalizedDate
string
Date the payer finished adjudicating the claim.
Example
"2026-04-15"
claims[].fromDate
string
First date of service covered.
Example
"2026-04-07"
claims[].toDate
string
Last date of service covered.
Example
"2026-04-07"
claims[].billedAmt
string
Charge the provider submitted for this claim or line.
Example
"150.00"
claims[].allowedAmt
string
Amount the plan allowed after contract discounts.
Example
"100.00"
claims[].paidAmt
string
Amount the plan paid.
Example
"70.00"
claims[].copayAmt
string
Flat copay the member owes.
Example
"10.00"
claims[].coinsuranceAmt
string
Member's percentage share of the allowed amount.
Example
"20.00"
claims[].deductibleAmt
string
Allowed amount applied to the member's deductible.
Example
"0.00"
claims[].patientResponsibilityAmt
string
Total the member owes after benefits.
Example
"30.00"
claims[].otherInsurancePaidAmt
string
Amount another carrier already paid on this claim.
Example
"0.00"
claims[].patientFirstName
string
Patient's given name as the payer has it.
Example
"Elena"
claims[].patientLastName
string
Patient's family name as the payer has it.
Example
"Whitcomb"
claims[].patientBirthDate
string
Patient's date of birth on the claim.
Example
"1988-09-23"
claims[].patientGender
string
Sex recorded for the patient.
Example
"F"
claims[].patientMemberId
string
Member id printed on the patient's card.
Example
"W000009876"
claims[].patientAccountNumber
string
Your own account number for the patient.
Example
"PAT00009876"
claims[].subscriberFirstName
string
Given name of the policy subscriber, who may not be the patient.
Example
"Elena"
claims[].subscriberLastName
string
Family name of the policy subscriber, who may not be the patient.
Example
"Whitcomb"
claims[].subscriberMemberId
string
Policyholder's member id on the plan.
Example
"W000009876"
claims[].payerId
string
Availity payer code the claim or appeal went to.
Example
"60054"
claims[].payerName
string
Payer brand name behind that payer code.
Example
"AETNA"
claims[].payerPhone
string
Number to call the payer about this claim.
Example
"8005550142"
claims[].providerName
string
Billing provider's last name or organization name only.
Example
"Example Ridge Orthopedic Clinic"
claims[].providerNpi
string
Billing provider's national provider identifier.
Example
"1999999984"
claims[].providerTaxId
string
Billing provider's tax identification number.
Example
"990001234"
claims[].checkNumber
string
Identifier on the payer's check or EFT.
Example
"0000987654"
claims[].checkDate
string
Date the payer issued the payment.
Example
"2026-04-16"
claims[].checkAmount
string
Amount on the payment check or EFT.
Example
"70.00"
claims[].checkStatus
string
Where the payment stands, for example issued or cleared.
Example
"Issued"
claims[].serviceLines
array
One entry per service line on the claim.
claims[].serviceLines[].lineNumber
integer
Position of this service line on the claim.
Example
1
claims[].serviceLines[].procedureCode
string
CPT or HCPCS code billed on this line.
Example
"99213"
claims[].serviceLines[].procedureCodeDescription
string
Plain wording for the billed procedure code.
Example
"Office or other outpatient visit for an established patient"
claims[].serviceLines[].quantity
string
Units of the procedure billed on this line.
Example
"1"
claims[].serviceLines[].status
string
Payer's reported processing outcome for this service entry.
Example
"Finalized"
claims[].serviceLines[].statusCode
string
Payer's X12 claim status code.
Example
"65"
claims[].serviceLines[].statusCodeDescription
string
Plain wording for that claim status code.
Example
"Claim/line has been paid."
claims[].serviceLines[].categoryCode
string
X12 claim status category code for the claim.
Example
"F1"
claims[].serviceLines[].categoryCodeDescription
string
Plain wording for the status category code.
Example
"Finalized/Payment"
claims[].serviceLines[].billedAmt
string
Charge the provider submitted for this claim or line.
Example
"150.00"
claims[].serviceLines[].allowedAmt
string
Amount the plan allowed after contract discounts.
Example
"100.00"
claims[].serviceLines[].paidAmt
string
Amount the plan paid.
Example
"70.00"
claims[].serviceLines[].copayAmt
string
Flat copay the member owes.
Example
"10.00"
claims[].serviceLines[].coinsuranceAmt
string
Member's percentage share of the allowed amount.
Example
"20.00"
claims[].serviceLines[].deductibleAmt
string
Allowed amount applied to the member's deductible.
Example
"0.00"
claims[].serviceLines[].fromDate
string
First date of service covered.
Example
"2026-04-07"
claims[].serviceLines[].toDate
string
Last date of service covered.
Example
"2026-04-07"
claims[].serviceLines[].diagnosisCodes
array
ICD codes on the line, or one joined string on appeals.
claims[].serviceLines[].customRemarks
array
Payer remark entries explaining the line's adjustments.
claims[].comment
string
Free text note the payer added to the claim.
Example
"Payment issued to billing provider."
claims[].lineOfBusiness
string
Plan family the claim falls under, like commercial or Medicare.
Example
"Commercial"
Code
curl --request POST \
  --url https://preview.ontross.com/api/integrations/availity/fetch-claims \
  --header 'X-API-Key: REPLACE_KEY_VALUE' \
  --header 'content-type: application/json' \
  --data '{"input":{"first_name":"Elena","last_name":"Whitcomb","member_id":"W000009876","date_of_service":"2026-04-07","date_of_birth":"1988-09-23","payer":"AETNA (COMMERCIAL & MEDICARE)","org_name":"Example Ridge Orthopedic Clinic"},"auth_id":"auth_uuid_here"}'
Request BODY
{
  "input": {
    "first_name": "Elena",
    "last_name": "Whitcomb",
    "member_id": "W000009876",
    "date_of_service": "2026-04-07",
    "date_of_birth": "1988-09-23",
    "payer": "AETNA (COMMERCIAL & MEDICARE)",
    "org_name": "Example Ridge Orthopedic Clinic"
  },
  "auth_id": "auth_uuid_here"
}
Response BODY
{
  "id": "string",
  "workflow_id": "string",
  "auth_id": "string",
  "status": "string",
  "input": {},
  "output": {
    "claims": []
  },
  "files": null,
  "created_at": "2019-08-24T14:15:22Z",
  "started_at": "2019-08-24T14:15:22Z",
  "completed_at": "2019-08-24T14:15:22Z"
}